The effect of hospital volume on mortality, morbidity and dissected lymph nodes in pancreaticoduodenectomy for periampullary region tumors

Abstract

Background/Aim: Since the first pancreaticoduodenectomy (PD) surgeries, mortality, morbidity and length of hospital stay decreased, in return, the number of uncomplicated cases and dissected lymph nodes increased over the years. The aim of our study was to determine the effect of hospital volume on survival, postoperative hospital stay, fistula rate, morbidity rate and the number of lymph nodes dissected. Methods: In this retrospective cohort study, 213 patients who were operated with the diagnosis of periampullary tumor between January 2008 and January 2016 were included in the study. The patients were divided into four groups according to the years of surgery: Group A (n=31, 2008-2009), Group B (n=46, 2010-2011), Group C (n=50, 2012-2013) and Group D (n=86, 2014-2016). The groups were compared with each other in terms of the following factors; Pancreatic fistula rates, postoperative hospital stay, mortality rates, morbidity rates, number of dissected lymph nodes. Results: It has been observed that there is a relation between pancreatic tissue quality and duct size with fistulas (P=0.0016 and P=0.017, respectively). It is seen that as the amount of number lymph nodules increases, the quality of staging improves (P=0.009). Rates of mortality and morbidity are decreased, as the hospital volume increased (P=0.037), The same effect of hospital volume is observed in length of hospital stay and fistula rates, both improved (P=0.017 and P<0.001, respectively). Conclusion: It is easy to state that the increase in hospital volume and surgeon’s experience is directly related with patient outcomes. As the understanding of anatomy increases, quality of the surgery is assumed to be increased as well as the reduction in length of hospital stay, mortality and morbidity rates, and the increase in quantity of dissected lymph nodules. '+st+' Perek S. İ.Ü. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri, Hepato-Bilier Sistem ve Pankreas Hastalıkları Sempozyum Dizisi. Pankreas kanseri. 2002;28:217-8. Sakin A, Sahin S, Sakin A, Atci M, Geredeli Ç, Cihan Ş. Effect of type 2 diabetes mellitus on survival in metastatic pancreatic cancer. J Surg Med. 2021;5(1):17-21. Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg. 2006;244(1):10-5. Crist DW, Sitzmann JV, Cameron JL. Improved hospital morbidity, mortality, and survival after the Whipple procedure. Ann Surg. 1987;206(3):358-65. Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997;226(3):248-60. Kuhlmann KFD, De Castro SMM, Wesseling, Ten Kate FJW, Offerhaus GJA, Busch ORC, et al. Surgical treatment of pancreatic adenocarcinoma: actual survival and prognostic factors in 343 patients. Eur j cancer, 2004;40(4):549-58. Makary MA, Winter JM, Cameron JL, Campbell KA, Chang D, Cunningham SC, et al. Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg. 2006;10:347–56. Mukaiya M, Hirata K, Satoh T, Kimura M, Yamashiro K, Ura H et al. Lack of Survival Benefit of Extended Lymph Node Dissection for Ductal Adenocarcinoma of the Head of the Pancreas: Retrospective Multi-institutional Analysis in Japan. World J Surg. 1998;22:248–53. Nagai H, Kuroda A, Morioka Y. Lymphatic and local spread of T1 and T2 pancreatic cancer. A study of autopsy material. Ann Surg. 1986;204(1):65-71. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13. Bassi C. International Study Group on Pancreatic Fistula Definition; Postoperative pancreatic fistula; an international study group (ISGPF) definition. Surgery. 2005;138:8-13. Tabachnick BG, Fidell LS. Using multivariate statistics. Boston: Allyn& Bacon; 2007. Silen V SM. Pancreas. In : Schwartz SI, Shires GT, Spencer FC, eds. Principles of Surgery 5. ed. McGraw- Hill; 1998. pp. 1413-1440. Jones L, Russell C, Mosca F, Boggi U, Sutton R, Slavin J, et al. Standard Kausch-Whipple Pancreatoduodenectomy. Dig Surg. 1999;16:297-304. Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med. 1979;301(25):1364-69. van Heek NT, Kuhlmann KF, Scholten RJ, de Castro SM, Busch OR, van Gulik TM, et al. Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg. 2005;242(6):781-90. Finlayson EVA, Goodney PP, Birkmeyer JD. Hospital Volume and Operative Mortality in Cancer Surgery: A National Study. Arch Surg. 2003;138(7):721–5. Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998;280:1747-51. Birkmeyer JD, Stukel TA, Siewers A, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;22:2117-27. Eppsteiner RW, Csikesz NG, McPhee JT, Tseng JF, Shah SA. Surgeon volume impacts hospital mortality for pancreatic resection. Ann Surg. 2009;249:635–40. Nordback I, Parviainen M, Raty S, Kuivanen H, Sand J. Resection of the head of the pancreas in Finland: effects of hospital and surgeon on short-term and long-term results. Scand J Gastroenterol. 2002;37:1454–60. Bachmann MO, Alderson D, Peters TJ, Bedford C, Edwards D, Wotton S, et al. Influence of specialization on the management and outcome of patients with pancreatic cancer. Br J Surg. 2003;90:171–7. Nathan H, Cameron JL, Choti MA, Schulick RD, Pawlik TM. The volume–outcomes effect in hepato-pancreato-biliary surgery: hospital versus surgeon contributions and specificity of the relationship. J Am Coll Surg. 2009;208:528–38. Ghaferi AA, Birkmeyer JD,...